Concordance between clinical and pathological staging in patients with stages I or II non-small cell lung cancer subjected to surgical treatment

• Published in: Jornal brasileiro de pneumologia 2007-11, Vol.33 (6), p.647-654
• Main Authors: Santos, Pedro Augusto Reck Dos, Rocha, Rodrigo Sponchiado da, Pipkin, Maurício, Silveira, Marner Lopes da, Cypel, Marcelo, Rios, Jayme Oliveira, Pinto, José Antonio Lopes de Figueiredo
• Format: Article
• Language: Portuguese
• Subjects: Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Data Interpretation, Statistical; Female; Humans; Lung Neoplasms - diagnosis; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymphatic Metastasis - diagnosis; Male; Mediastinoscopy - standards; Middle Aged; Neoplasm Staging - methods; Predictive Value of Tests; Retrospective Studies; Tomography, X-Ray Computed - standards
• ISSN: 1806-3756

To compare clinical and pathological staging in patients with non-small cell lung cancer submitted to surgical treatment, as well as to identify the causes of discordance. Data related to patients treated at the Department of Thoracic Surgery of the Pontifical Catholic University of Rio Grande do Sul São Lucas Hospital were analyzed retrospectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for clinical stages IA, IB, and IIB. The kappa index was used to determine the concordance between clinical and pathological staging. Of the 92 patients studied, 33.7% were classified as clinical stage IA, 50% as IB, and 16.3% as IIB. The concordance between clinical and pathological staging was 67.5% for stage IA, 54.3% for IB, and 66.6% for IIB. The accuracy of the clinical staging was greater for stage IA, and a kappa of 0.74, in this case, confirmed a substantial association with pathological staging. The difficulty in evaluating nodal metastatic disease is responsible for the low concordance in patients with clinical stage IB. The concordance between clinical and pathological staging is low, and patients are frequently understaged (in the present study, only one case was overstaged). Strategies are necessary to improve clinical staging and, consequently, the treatment and prognosis of patients with non-small cell lung cancer.